Timentin

ticarcillin disodium and clavulanate potassium

Timentin

Pharmacologic class: Penicillin (extended-spectrum)

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Ticarcillin disodium inhibits bacterial cell-wall synthesis during replication; clavulanic acid extends ticarcillin's antibiotic spectrum by inactivating beta-lactamase enzymes (which otherwise would degrade ticarcillin).

Availability

Injection: 3 g ticarcillin and 100 mg clavulanic acid in 3.1-g vials

Indications and dosages

Systemic and urinary tract infections caused by susceptible organisms

Adults weighing more than 60 kg (132 lb): 3.1 g (30:1 fixed-ratio combination of 3 g ticarcillin and 100 mg clavulanic acid) by I.V. infusion q 4 to 6 hours

Adults weighing less than 60 kg (132 lb): 200 to 300 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 4 to 6 hours

Gynecologic infections caused by susceptible organisms

Adults weighing more than 60 kg (132 lb): For moderate infections, 200 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 6 hours. For severe infections, 300 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 4 hours.

Adults weighing less than 60 kg (132 lb): 200 to 300 mg/kg/day by I.V. infusion q 4 to 6 hours

Mild to moderate or severe infections in children caused by susceptible organisms

Children weighing more than 60 kg (132 lb): For mild to moderate infections, 3.1 g (30:1 fixed-ratio combination of 3 g ticarcillin and 100 mg clavulanic acid) by I.V. infusion q 6 hours. For severe infections, 3.1 g (30:1 fixed-ratio combination of 3 g ticarcillin and 100 mg clavulanic acid) by I.V. infusion q 4 hours.

Children ages 3 months to 16 years weighing less than 60 kg (132 lb): For mild to moderate infections, 200 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 6 hours. For severe infections, 300 mg/kg/day (based on ticarcillin content) by I.V. infusion in divided doses q 4 hours.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug or other penicillins

Precautions

Use cautiously in:

• cystic fibrosis, renal or hepatic disease

• pregnant or breastfeeding patients.

Administration

• Ask patient about penicillin allergy before giving.

• Add 13 ml of sterile water or normal saline solution to vial; shake gently. Dilute further to 10 to 100 mg/ml of ticarcillin; infuse I.V. over 30 minutes.

• Give at least 1 hour before I.V. aminoglycosides (such as amikacin or gentamicin).

Adverse reactions

CNS: headache, giddiness, dizziness, lethargy, fatigue, hyperreflexia, neuromuscular excitability, asterixis, hallucinations, stupor, seizures

GI: nausea, vomiting, diarrhea, flatulence, pseudomembranous colitis

Hematologic: eosinophilia, transient neutropenia and leukopenia (with high doses)

Skin: urticaria, rash

Other: unpleasant taste; fever; overgrowth of nonsusceptible organisms; pain, vein irritation, erythema, phlebitis, and thrombophlebitis at I.V. site; hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Aminoglycosides: physical incompatibility, causing aminoglycoside inactivation when mixed in same I.V. solution

Aminoglycosides, tetracyclines: additive activity against some bacteria

Lithium: altered lithium elimination

Probenecid: increased ticarcillin blood level

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, eosinophils, lactate dehydrogenase, sodium: increased levels

Bleeding time: prolonged

Granulocytes, hemoglobin, platelets, white blood cells: decreased levels

Liver function tests: transient increases

Urine glucose, urine protein: false-positive results

Patient monitoring

• Monitor liver function tests and CBC with white cell differential.

• Watch closely for signs and symptoms of superinfection and severe allergic reactions.

• Assess neurologic status, and stay alert for seizures.

Patient teaching

Advise patient to report skin reactions and severe diarrhea right away.

Tell patient drug may increase risk of other infections. Advise him to promptly report signs and symptoms of new infection.

• Instruct patient to limit sodium intake (drug contains sodium).

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

ticarcillin/clavulanate

(tye-kar-sil-in/klav-yoo-la-nate) ,

Timentin

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: extended spectrum penicillins
Pregnancy Category: B

Indications

Treatment of:
  • Skin and skin structure infections,
  • Bone and joint infections,
  • Septicemia,
  • Lower respiratory tract infections,
  • Intra-abdominal, gynecologic, and urinary tract infections.

Action

Binds to bacterial cell wall membrane, causing cell death.
Addition of clavulanate enhances resistance to beta-lactamase, an enzyme that can inactivate penicillins.

Therapeutic effects

Bactericidal action.
Similar to penicillin but extended to include several gram-negative aerobic pathogens, notably:
  • Pseudomonas aeruginosa,
  • Escherichia coli,
  • Citrobacter,
  • Enterobacter,
  • Haemophilus influenzae,
  • Klebsiella,
  • Serratia marcescens.
Active against some anaerobic bacteria, including bacteroides.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed. Enters CSF well when meninges are inflamed. Crosses the placenta; enters breast milk in low concentrations.
Metabolism and Excretion: 10% of ticarcillin is metabolized by the liver; 90% excreted unchanged by the kidneys. Clavulanate is metabolized by the liver.
Half-life: Ticarcillin—1.1 hr (↑ in renal impairment); clavulanate—1.1 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusion4–6 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to penicillins (cross-sensitivity with cephalosporins may occur).
Use Cautiously in: Renal impairment (dose ↓ and/or ↑ interval required if CCr <60 mL/min);HF (due to high sodium content); Obstetric / Lactation: Safety not established; Pediatric: Children <3 mo (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • seizures (high doses) (life-threatening)
  • confusion
  • lethargy

Cardiovascular

  • chf (life-threatening)
  • arrhythmias

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • nausea

Genitourinary

  • hematuria (children only)
  • hemorrhagic cystitis

Dermatologic

  • rash (most frequent)
  • urticaria

Fluid and Electrolyte

  • hypokalemia (most frequent)
  • hypernatremia

Hematologic

  • bleeding
  • blood dyscrasias
  • ↑ bleeding time

Local

  • phlebitis (most frequent)

Metabolic

  • metabolic alkalosis

Miscellaneous

  • hypersensitivity reactions including anaphylaxis (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

Probenecid ↓ renal excretion and ↑ blood levels.

Route/Dosage

Ticarcillin/clavulanate contains 4.51 mEq sodium/g and 0.15 mEq potassium/g of ticarcillin/clavulanate. 3 g ticarcillin plus 100 mg clavulanate labeled as 3.1 g combined potency. Dosing is based on ticarcillin component.
Intravenous (Adults and Children >16 yr) 3 g ticarcillin q 4–6 hr.
Intravenous (Children 3 mo–16 yr) <60 kg—Mild to moderate infection: 50 mg ticarcillin/kg q 6 hr; severe infection: 50 mg ticarcillin/kg q 4 hr. ≥60 kg—Mild to moderate infection: 3 g ticarcillin q 6 hr; severe infection: 3 g ticarcillin q 4 hr.

Renal Impairment

Intravenous (Adults) Give loading dose of 3 g ticarcillin × 1 dose, followed by maintenance dose based on CCr. CCr 30–60 mL/min—2 g ticarcillin q 4 hr; 10–30 mL/min—2 g ticarcillin q 8 hr; CCr <10 mL/min—2 g ticarcillin q 12 hr; CCr <10mL/min with hepatic dysfunction—2 g ticarcillin q 24 hr; Peritoneal dialysis—3 g ticarcillin q 12 hr; Hemodialysis—2 g ticarcillin q 12 hr supplemented with 3 g ticarcillin after each dialysis session.

Availability

Powder for injection: 3.1 g/vial, 31 g/vial
Premixed infusion: 3.1 g/100 mL

Nursing implications

Nursing assessment

  • Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Obtain a history before initiating therapy to determine use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
  • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: Evaluate renal and hepatic function, CBC, serum potassium, and bleeding times prior to and routinely throughout therapy.
    • May cause false-positive urine protein testing and increased BUN, creatinine, AST, ALT, serum bilirubin, alkaline phosphatase, LDH, and uric acid levels. May also cause ↑ bleeding time.
    • May cause hypernatremia and hypokalemia with high doses.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)

Implementation

  • Intravenous Administration
  • Intravenous: Change IV sites every 48 hr to prevent phlebitis.
  • Intermittent Infusion: Add 13 mL of sterile water for injection or 0.9% NaCl for injection to each 3.1-g vial, to provide a concentration of ticarcillin 200 mg/mL and clavulanic acid 6.7 mg/mL. Diluent: Further dilute in 0.9% NaCl, D5W, or LR. Reconstituted vials stable for 24 hr at room temperature or 72 hr if refrigerated. Infusion is stable for 24 hr at room temperature. If refrigerated, infusion is stable for 3 days (diluted in D5W) or 7 days (if diluted in 0.9% NaCl or LR). Concentration: 10–100 mg/mL.
  • Rate: Infuse over 30 min.
  • Y-Site Compatibility: alfentanyl, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplastin, carmustine, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone sodium phosphate, dexmedetomidine, digoxin, diltiazem, diphenhydramine, docetaxel, dopamine, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, esmolol, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone sodium succinate, hydromorphone, ifosfamide, imipenem/cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitil, mechlorethamine, melphalan, meperidine, methotrexate, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, metronidazole, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, penicillin G, perphenazine, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium acetate, potassium chloride, procainamide, prochlorperazine, propofol, propranolol, pyridoxime, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimetaphan, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, voriconazole, zoledronic acid
  • Y-Site Incompatibility: acyclovir, alemtuzumab, amphotericin B cholesteryl, azithromycin, caspofungin, chlorpromazine, dantrolene, diazepam, diazoxide, dobutamine, epirubicin, erythromycin, ganciclovir, haloperidol, hydroxyzine, idarubicin, mitoxantrone, mycophenolate, papaverine, pentamidine, pentazocine, phenytoin, promethazine, protamine, quinupristin/dalfopristin, tranexamic acid, trimethoprim/sulfamethoxazole.If aminoglycosides and penicillins must be administered concurrently, administer in separate sites at least 1 hr apart.

Patient/Family Teaching

  • Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy.
  • Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

Timentin

(tī′mĕn′tn)
A trademark for a drug containing ticarcillin disodium and a potassium salt of clavulanic acid.

Timentin

AIDS A parenteral antibacterial used to manage skin infections. See AIDS.
References in periodicals archive ?
2-lactam antibiotics such as cefotaxime, carbecillin and timentin were exploited in protoplast cultures of carrot at a range of 100-500mg/L (24).
After co-cultivation the inoculated embryos were subjected to two sub culturing cycles of 15 days each on callus induction media supplemented with 160 mg L-1 Timentin (15:1 Ticarcillin disodium to Potassium Clavulanate cat # 42010012-4 bioplus USA) for the suppression of Agrobacterium.
Ticarcillin-clavulanate (100 mg/kg; Timentin, GlaxoSmithKline, Philadelphia, PA, USA) also was infused in each joint.
Augmentin and timentin were used for suppressing Agrobacterium tumefaciens during tomato (Lycopersicon esculentum) genetic transformation (Ieamkhang and Chatchawankanphanich, 2005).
Regenerating plantlets were transferred to magenta boxes containing 50ml of hormone-free half strength CIM solidified by 2g/l Gerlite and supplemented with 75mg/l Timentin and 25mg/l hygromycin B.
Afterwards, they were transferred to somatic embryogenesis induction medium with antibiotic timentin (200mg/l) and incubated similarly for 10-12 days.
The patient remained febrile and was commenced on timentin (IV, 3.
The day after admission he was still febrile and was given Timentin (ticarcillin plus clavulinic acid), gentamicin, and doxycycline.
1] Timentin overnight to eliminate the Agrobacterium before incubation in the X-Gluc solution.
Antibiotics such as cefotaxime, carbenecillin, and timentin have been used regularly in Agrobacterium- mediated transformation of crops following co-culture to suppress or eliminate Agrobacterium (Bottinger et al.
Vancomycin and timentin were commenced and drainage of the empyema was made by a thoracotomy and intercostal catheter through the wall of the empyema and distant to the site where the empyema was pointing.
Enrofloxacin was replaced with amikacin sulfate (15 mg/kg IM q12h), ticarcillin disodium/clavulanate potassium (200 mg/kg IM q12h; Timentin, GlaxoSmithKline, Research Triangle Park, NC, USA), and metronidazole (50 mg/kg PO q12h; compounded by LSU-VMTH into a 50 mg/ml suspension).